Thursday, July 30, 2009

I've never been pushpolled before. I've never even heard of anyone being push-polled (outside of the US).

I was asked to participate in a short survey. I was somewhat suspicious ("surveys" are often thinly disguised marketing), but the guy promised 3 minutes, and I thought, "what the heck".

So I was asked about my attitude to a proposal to increase cigarette taxes.I gave my answer, and began to think it might be legit after all.

I was then asked a series of carefully-worded and ordered questions, and became increasingly suspicious that something was up, because the questions seemed increasingly designed to elicit a particular response in opposition to the tax increase. After four minutes (okay, so he fibbed, but not by a whole lot), the guy (an Indian, as usual) asked "Given what you now know about the proposal ..." and then it was the exact same FIRST question I had been asked.

Now I didn't know anything I hadn't known before (apart from some slightly dubious statements in the questions that I didn't attach much credence to - but I'm a skeptic; a lot of people would probably accept them as true). To ask the question again implied it was expected I might have changed my mind. No legitimate poll does it like that. I guess most people wouldn't realize what was up, but I was peeved.

I just said "I've already answered that question", and got off as fast as I could, but DAMN I'm annoyed now.

The results of the SECOND asking of that question will no doubt be used to fuel a push to oppose the proposal (with, of course, no mention of the tricks it took to lead people to that answer).

Expect some agitation from this puppy, you ghouls. I haz internets and access to bordz and groopz. You don't entwine me in your devious little push-polls without some push-back.

Sunday, July 12, 2009

"...and that's exactly what's going on in Canada and Great Britain today. They don't have the appreciation of life, as we do in our society, evidently. And, um. Dr. Roe, a lot of people are gonna die, this program of 'government option' is being touted as being this panacea, the savior of allowing people to have quality health care at an affordable price -- is gonna kill people."

Let's get this straight. EVERY form of health care will lead to deaths.

Any society has finite resources. Any time you spend those resources on anything whatever, you're not spending those resources on saving a life that might have been saved otherwise. Even when you're spending the resources on saving a life over here, you're not spending them on saving a life over there. If you install that traffic light, you might have spent it on heart medication. If you build that school, you might have spent it on cancer research. If you build that bridge, you might have spent it on an MRI machine. But the traffic light, the school and the bridge also improve survival...

And it's not just government expenditure. Buying a boat rather than donating money that could save lives is a health care choice too.

The one constant then, is that under any form of health care, under any form of public and private expenditure, people die. It is a nonsense to pretend otherwise.

The question is not whether health care will be rationed. It always is. The question is not whether bureaucrats will be involved in health care decisions. They always will.

The question is when and where resources will be spent. This always comes down to what treatments are effective and where to get value for the resources that are spent.

Currently an overwhelming proportion of health care expenditure in the US is spent to keep very old people, mostly very wealthy people, alive for another couple of months, at the expense, frequently, of children and babies, had some of those resources been spent on younger, poorer people.

Any way you try to allocate those resources, people die. The thing is, if you reallocate only a tiny amount of that expenditure toward younger, poorer people, the overall impact on survival can be very dramatic indeed.

The UK and Canadian systems (and for that matter, the Australian one) are imperfect. As far as I understand, they all involve some form of judging what is effective treatment.

If there are two similar treatments, but one costs twenty times as much for only fractionally better outcomes, the public systems will tend to plump for the cheaper one - because you can treat twenty times as many people with it! (As Cujo rightly points out in comments, similar decisions happen with private providers in the US as well - though obviously their priorities are slightly different.)

Overall, these decisions do a fairly good job of allocating resources away from less effective or marginally-effective-but-hugely-expensive treatments, in order to make the health of the society as a whole somewhat better. But government involvement in providing some minimal health care doesn't stop wealthy people being able to buy additional health care.

Every system involves rationing. The present US system rations health care quite dramatically. Firstly, millions of people don't have health cover at all, and for many that do, their provider strictly rations what health care is provided - the main problem is that their decisions are not only predicated on value for money. Again, the question is not "will health care be rationed?", the question is "what is rationed, and in what circumstances?".

On its northern border, the US has a neighbor that has universal health care. However, it is not a single system - there's a different system in each province. There's been a long-running experiment right on the doorstep of the US, with different approaches to providing health care (link is to Snopes article debunking claims about Canadian health system).

It would be easy to examine what works well and what doesn't about each system. There are many other systems around the industrialized world, with different methods of paying for care and different approaches to providing it. The US is in a uniquely privieleged position to see what works, and has the ability to find out what the users of each system think of their health care and its costs.

I live in a system that has private and public components. It is not cheap, and it is far from perfect, but it is still cheaper than what you presently have in the US and (usually) does better at providing a minimal level of basic health care to the poor.

The US has a unique opportunity to get it right. But there are some people whose aim is to scare you out of making a considered decision, and the private health industry is spending enormous amounts on lobbying politicians (and people in the media) to make sure that you don't. The result is you get told a lot of lies and half-truths and get conclusions based on bad assumptions. If you pay attention to the scare mongers (mostly politicians with pockets filled by the private health insurers and incredibly wealthy media people whose concerns are very different from that of the ordinary working person), they will create so much smoke that proper, considered decision making will become politically impossible. And the only certainy then is that no matter what health care system you get, you will end up with worse health care than you could have.

So, Rep. Broun, do we spend a little and save perhaps a dozen babies, or is extending the painful death of someone in the unavoidable process of dying, for perhaps another few days, really more important to you?